Quality Indicators of Continuity and Coordination of Care for Vulnerable Elder Persons

摘要

Continuity and coordination of care are attributes of medical care that influence its quality. Donabedian describes coordination of care as the process by which the elements and relationships of medical care during any one sequence of care are fitted together in an overall design. Continuity means lack of interruption in needed care, and the maintenance of the relatedness between successive sequences of medical care. A fundamental feature of continuity is the preservation of information about past findings, evaluations and decisions, and the use of these in current management. Coordination involves the sharing of such information among a number of providers to achieve a coherent scheme of management. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines this function as 'matching the patient's needs with the appropriate level and type of medical, health and social services.' The JCAHO national Library of Healthcare Indicators (NLHI) defines continuity as the degree to which the care for the patient is coordinated among practitioners, among organizations and over time. Among the 1997 set of 123 NHLI quality-of-care indicators, 87 included a component representing continuity. Continuity and coordination of care are particularly important for older patients because they are apt to have multiple medical problems which may be treated by several clinicians. The complexity of treating multiple conditions simultaneously requires explicit coordination of care.